Safety and efficacy of fortified antibiotics and fluoroquinolones for the treatment of bacterial keratitis: A meta-analysis

PURPOSE

To compare the safety and efficacy of fortified antibiotics and fluoroquinolones in the treatment of bacterial keratitis.

METHODS

PubMed, EMBASE, Cochrane Library, CNKI, Wanfang database and VIP database were systematically searched for randomized controlled trials (RCT) of treatment of bacterial keratitis with fortified antibiotics and fluoroquinolones. Rev Man 5.3 software was used to analyze outcome index cure rate, time to cure, and adverse events in a meta-analysis.

RESULTS

After literature search and screening, 9 randomized controlled trials were included in this study. Compared with traditional fortified antibiotic therapy, fluoroquinolones show consistency in terms of cure rate and incidence of adverse events: cure rates (OR=0.99, 95% CI: 0.75, 1.30) and incidence of adverse events (OR=0.75, 95% CI: 0.48, 1.17). However, the time to cure for fluoroquinolones was shorter than that of fortified antibiotics (MD=0.96, 95% CI: 0.50, 1.41).

CONCLUSION

The cure rate and safety of fluoroquinolones are equivalent to those of fortified antibiotics, so it seems reasonable to use fluoroquinolones as the preferred treatment for bacterial keratitis.

The effect of climatic and seasonal factors on the microbial keratitis profile

PURPOSE

To compare retrospective data on microbial keratitis (MK) from two different climatic regions in Turkey over 11 years.

STUDY DESIGN

Retrospective cohort.

METHODS

This retrospective cohort study included patients diagnosed with presumed MK at two referral centers. Center A was located in the subtropical region of Turkey, whereas Center B was located in a continental temperate climate zone. Clinical and laboratory data were also recorded. The results were evaluated for seasonal variations.

RESULTS

This study included data from 665 patients with presumed MK (351 and 314 patients from centers A and B, respectively). The most common predisposing factors were ocular trauma in Center A, prior ocular surgery, and systemic disease in Center B. Severe keratitis was related to prior ocular surgery, presence of systemic disease, and fungal infection at presentation. The culture positivity rate was higher in spring and lower in summer at both centers. Gram-positive bacteria were the most commonly isolated bacteria in both centers in all seasons. The fungal and mixed keratitis ratios were higher in Center A than in Center B. In Center A, filamentous fungi were common pathogens that were found year-round, and peaks were observed in July and October.

CONCLUSION

The results of this study show that climatic and seasonal factors may affect the microbial profile of keratitis. Fungal keratitis appears to be a climatic disease. Understanding the regional profile of MK can aid clinicians in their disease management.

[Clinical and microbiological features of severe infectious keratitis during heatwaves]

PURPOSE

To study clinical and microbiological features of patients with severe microbial keratitis during a heatwave. To evaluate the links between disease severity, causative micro-organisms and temperature variation.

METHODS

Retrospective study of patients with microbial keratitis hospitalized in a referral center during the summer months (between June 1, 2009 and September 30, 2009), separated into two groups by date of hospitalization (heatwave vs non-heatwave). Prevalence and daytime temperatures were compared for data collected during the summers of 2009 (heatwave), 2008 (temperate) and 2003 (prolonged heatwave).

RESULTS

Thirty-three patients were hospitalized during the summer of 2009, with an average age of 51 years and an average stay of 15 days. The primary predisposing factor was the use of contact lenses (36%), followed by pre-existing corneal disease (15%) and systemic disease (15%). Prevalence of severe keratitis was higher in periods of heatwaves vs periods of no heatwaves (mean 9.8 patients vs 3.1, P<0.001). Best corrected visual acuity progressed from 1/30 at admission to 1/10 at 1 month after discharge (P<0.001). The most common bacteria identified were Gram-positive cocci (CNS 27%) and Pseudomonas (23%). Microbiological results were similar in the two groups. Similar variations between the prevalence of severe keratitis and daytime temperatures were found for the summer of 2009 as well as for the summers of 2008 and 2003.

CONCLUSIONS

There appears to be a link between climatic temperature variations and the prevalence of severe microbial keratitis.